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Chlamydia pneumoniae: Possible Association With Asthma in Children

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Chlamydia pneumoniae:

Possible Association With

Asthma in Children

Chlamydia pneumoniae has been

recog-nized as a common cause of

communi-ty-acquired pneumonia (CAP) and

other acute respiratory infections (ARIs)

in various age groups [

1

]. Lately, the

prev-alence of Chlamydia-associated ARIs has

decreased to <1.5% [

2

], as a result of

changes in epidemiology of C.

pneumo-niae and increased speci

ficity of new

di-agnostic molecular methods. Moreover,

C. pneumoniae infection may remain

un-detected as clinicians may not screen the

infected population. Indeed, Chlamydia

pneumoniae has been recently identified

as an agent of asthma exacerbation

and has been associated with its severity

[

3

5

], thus reinforcing the importance

of targeting these patients. In Lausanne,

using a duplex real-time polymerase

chain reaction (PCR) that detects C.

pneumoniae and Mycoplasma

pneumo-niae DNA [

6

], we reported a 0.13%

prev-alence of C. pneumoniae–positive PCRs

(2/1583) and identi

fied 1 patient with C.

pneumoniae–associated asthma, who

re-covered with antibiotics [

7

]. Below, we

re-port a case series of C. pneumoniae

respiratory infections in children.

From 10 September to 5 December 2013,

C. pneumoniae was detected in upper

re-spiratory tract specimens from 8 children

(Table

1

). Of these, 5 were admitted for

either acute asthma exacerbation or

asth-matic bronchitis. All but 2 patients

present-ed with chronic cough without fever or

systemic symptoms. These two patients,

one with CAP who was coinfected with

M. pneumoniae (patient 7) and the other

one with severe asthma exacerbation who

was coinfected with rhinovirus (patient 8),

were admitted for severe respiratory distress

in the intensive care unit, intubated, and

mechanically ventilated. Both patients

with severe clinical presentation were

con-firmed asthmatics. All patients were

successfully treated with a macrolide.

In-terestingly, C. pneumoniae infection was

detected by chance in 7 patients as a result

of the dual format of our PCR, because a

M. pneumoniae PCR was requested.

In conclusion, this report supports the

role of C. pneumoniae in asthma

exacerba-tion. Whether C. pneumoniae-associated

asthma may be cured with antibiotics or

will also require steroids remains unknown

and may vary from patient to patient. This

case series underlines the importance of

screening asthmatic children for C.

pneu-moniae. Moreover, our

findings suggest

that C. pneumoniae prevalence is likely

un-derestimated and children with chronic

cough, even in absence of fever, should

be tested for C. pneumoniae.

Note

Potential conflicts of interest. All authors: No reported conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Sandra A. Asner,1,2Katia Jaton,3 Sofiaanna Kyprianidou,1 Anna-Maria Libudzic Nowak,1and Gilbert Greub2,3

1

Unit of Pediatric Infectious Diseases and Vaccinology, Department of Paediatrics, University Hospital Center;

2

Service of Infectious Diseases, Department of Internal

Table 1.

Baseline Characteristics of Children Identi

fied With C. pneumoniae

Patient Age, y Sex Asthmatic Condition Cough

Duration Fever ICUa Sample

Copies/

mL Coinfection Treatment

Treatment Duration 1b 7 F Asthma Chronic Yes No Throat 1 743 796 No Clarithromycin 14 d

2 7 M Asthma Chronic Yes No Nasal 197 000 No Clarithromycin 10 d 3b 7 M None Chronic No No Throat 3100 No Clarithromycin 10 d

4 6 M None Chronic No No Nasal 60 No Azithromycin 5 d

5b 8 M Asthmatic

bronchitis

Chronic No No NP 78 000 No Clarithromycin 7 d 6b 12 F None Chronic No No NP 61 000 No Clarithromycin 7 d 7 7 F Asthma Acute Yes Yes NP 170 Mycoplasma

pneumoniae (570 copies/mL)

Clarithromycin 14 d

8 10 M Asthma Acute Yes Yes NP 208 Rhinovirus (13 071 000 copies/mL)

Erythromycin 14 d

Abbreviations: ICU, intensive care unit admission; NP, nasopharyngeal. a

Patient 7 was admitted to the ICU for community-acquired pneumonia; patient 8, for a severe asthma exacerbation. b

Patient originated from the same eastern region of Vaud canton (nearby Yverdon).

(2)

Medicine, University Hospital Center; and3Institute of Microbiology, Department of Laboratory, University of Lausanne and University Hospital Center, Switzerland

References

1. Grayston JT, Campbell LA, Kuo CC, et al. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis1990; 161:618–25.

2. Kumar S, Hammerschlag MR. Acute respira-tory infection due to Chlamydia pneumoniae: current status of diagnostic methods. Clin In-fect Dis2007; 44:568–76.

3. Hahn DL, Schure A, Patel K, Childs T, Drizik E, Webley W. Chlamydia pneumoniae-specific IgE is prevalent in asthma and is associated with disease severity. PLoS One2012; 7:e35945. 4. Hahn DL, Peeling RW. Airflow limitation, asthma, and Chlamydia pneumoniae-specific heat shock protein 60. Ann Allergy Asthma Immunol2008; 101:614–8.

5. Hahn DL, Peeling RW, Dillon E, McDonald R, Saikku P. Serologic markers for Chlamydia pneumoniae in asthma. Ann Allergy Asthma Immunol2000; 84:227–33.

6. Welti M, Jaton K, Altwegg M, Sahli R, Wenger A, Bille J. Development of a multiplex real-time quantitative PCR assay to detect Chla-mydia pneumoniae, Legionella pneumophila and Mycoplasma pneumoniae in respiratory tract secretions. Diagn Microbiol Infect Dis 2003; 45:85–95.

7. Senn L, Jaton K, Fitting JW, Greub G. Does respiratory infection due to Chlamydia pneu-moniae still exist? Clin Infect Dis2011; 53: 847–8.

Correspondence: Gilbert Greub, MD, PhD, Institute of Microbi-ology, Department of Laboratory, Rue du Bugnon 48, 1011 Lau-sanne (Vaud), Switzerland (gilbert.greub@chuv.ch). Clinical Infectious Diseases 2014;58(8):1198–9 © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals. permissions@oup.com.

DOI: 10.1093/cid/ciu034

Figure

Table 1. Baseline Characteristics of Children Identi fi ed With C. pneumoniae

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